BMCH2015-0286Applicant:
GENERAL AIR CONDITIONING & HEA
OUTSIDE CITY LIMITS
Lr�
JUL 2 0 2015
L_
CfjY OF LA QUINTA
COI AMUNITY DEVELOPMENT DEPART% -!-X i
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: License No.: :LIC -0003606
Date:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair
any structure, prior to its issuance, also requires the applicant for the permit to file a
signed statement that he or she is licensed pursuant to the provisions of the
Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3
of the Business and Professions Code) or that he or she is exempt therefrom and the
basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for
permit subjects the applicant to a civil penalty of not more than five hundred dollars
($500).:
( ) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for sale.
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
apply to an owner of property who builds or improves thereon, and who does the work
himself or herself through his or her own employees, provided that the improvements
are not intended or offered for sale. If; however, the building or improvement is sold
within one year of completion, the owner -builder will have the burden of proving that
he or she did not build or improve for the purpose of sale.).
(_) I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of property who builds or improves
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
( ) I am exempt under Sec.. B.&P.C. for this reason
Contractor:
Date
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Add
Contractor: -
GENERAL AIR CONDITIONING & HEA
OUTSIDE CITY LIMITS
(760)343-7490
Llc. No.: :LIC -0003606
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
. I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the performance
of the work for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this permit
is issued. My workers' compensation insurance carrier and policy number are:
Carrier: Policy Number:
_ I certify that in the performance of the work for which this permit is issued, I
shall not employ anyperson in any manner so as to become subject to the workers'
compensation laws of California, and agree that, if I should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions..
Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose
request and for whose benefit work is performed under or pursuant to any permit
issued as a result of this application , the owner, and the applicant, each agrees to, and
shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
employees for any act or omission related to the work being performed under or
following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is
not commenced within 180 days from date of issuance of such permit, or cessation of
work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the above-
mentioned property for inspection purposes.
Signature (Applicant or Agent):
4 rC(/
VOICE (760) 777-7125
78-495 CALLE TAMPICO
U
FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253
COMMUNITY DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 7/20/2015
Application Number:
BMCH2O15-0286
Owner:
Property Address:
52060 AVENIDA RUBIO
LOIS POWER
APN:
773213003
52060 AVENIDA RUBIO
Application Description:
REPLACE (1) 4TON UNIT
SPLIT SYSTEM
LA QUINTA, CA 92253
Property Zoning: .
Application Valuation:
$9,588.00
Applicant:
GENERAL AIR CONDITIONING & HEA
OUTSIDE CITY LIMITS
Lr�
JUL 2 0 2015
L_
CfjY OF LA QUINTA
COI AMUNITY DEVELOPMENT DEPART% -!-X i
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: License No.: :LIC -0003606
Date:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair
any structure, prior to its issuance, also requires the applicant for the permit to file a
signed statement that he or she is licensed pursuant to the provisions of the
Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3
of the Business and Professions Code) or that he or she is exempt therefrom and the
basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for
permit subjects the applicant to a civil penalty of not more than five hundred dollars
($500).:
( ) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for sale.
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
apply to an owner of property who builds or improves thereon, and who does the work
himself or herself through his or her own employees, provided that the improvements
are not intended or offered for sale. If; however, the building or improvement is sold
within one year of completion, the owner -builder will have the burden of proving that
he or she did not build or improve for the purpose of sale.).
(_) I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of property who builds or improves
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
( ) I am exempt under Sec.. B.&P.C. for this reason
Contractor:
Date
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Add
Contractor: -
GENERAL AIR CONDITIONING & HEA
OUTSIDE CITY LIMITS
(760)343-7490
Llc. No.: :LIC -0003606
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
. I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the performance
of the work for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this permit
is issued. My workers' compensation insurance carrier and policy number are:
Carrier: Policy Number:
_ I certify that in the performance of the work for which this permit is issued, I
shall not employ anyperson in any manner so as to become subject to the workers'
compensation laws of California, and agree that, if I should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions..
Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose
request and for whose benefit work is performed under or pursuant to any permit
issued as a result of this application , the owner, and the applicant, each agrees to, and
shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
employees for any act or omission related to the work being performed under or
following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is
not commenced within 180 days from date of issuance of such permit, or cessation of
work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the above-
mentioned property for inspection purposes.
Signature (Applicant or Agent):
4NCIAL INFCIRMATIC
.-
z*DESCRIPTION 1 ACCOUNT ,'. E ""QTY AMOUNT F PAID PAID'DATE
BSAS SB1473 FEE
101-0000-20306 0. $1.00
$0.00
y z PAID BY;
r i .
-aMETHOD s , `RECEIPT # '�
CHEC K #. CLTD BYa`
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA $1.00
$0.00
DESCRIPTION`
ACCOUNT T
QTY
x; AMOUNT*PAID-,m
PAID DATE.
HVAC CHANGEOUT - SPLIT -SYSTEM
101-0000-42402
0
$72.52
$0.00
a
r PAID BY r�
"r`' METHOD
RECEIPT #
•]
s CHECK #
CLTD BY '
r 7, DESCRIPTIN ' 4
Q OPAID
p ACCOUNT i
QTYa-'AMOUNT,,PAID
DATE:
HVAC CHANGEOUT - SPLIT -SYSTEM PC
101-0000-42600
0
$36.26
$0.00
f PAID BY *
k • ' , METHOD '
RECEIPT :# , ' ?
CHECK #
:CLT...
BY `
Total Paid forCHANGEOUT: $108.78
$0.00
R ' 'DESCRIPTION
I
T ACCOUN`
;:QTY'
AMOUNT-
w
J PAID a
PAID DATE;
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
` y PAID By `-,, _ + ' `
METHOD
;RECEIPT #
CHECK #,
CLTD B1f `
Total Paid for PERMIT ISSUANCE: $91.85
$0.00
TOTALS:00
• s.
�
r
Description: REPLACE (1) 4TON UNIT SPLIT SYSTEM
Type: MECHANICAL Subtype:
Status: UNDER REVIEW
Applied: 7/20/2015 PJU
Approved:
Parcel No: 773213003 Site.Address: 52060 AVENIDA RUBIO LA QUINTA,CA 92253
Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 3
Lot: 20
Issued:
UNIT 1
Lot Sq Ft: 0 Building Sq Ft: 0
Zoning:
Finaled:
Valuation: $9,588.00 Occupancy Type:
Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0
No. Unites: 0
Details: REPLACE ONE 4 TON SYSTEM CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2013 CALIFORNIA
BUILDING CODES.
Printed:. Monday, July 20, 2015 2:11:57 PM 1 of 2
sysrrtts
__ _
__ __ _..
__,W
_._�.. W ._
___,___
CLTD
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAIPAID
D
DATE
RECEIRT_#
CHECK # :
METHOD
PAID BY
HVAC CHANGEOUT -
101-0000-42402
0
$72.52
$0.00
SPLIT -SYSTEM
HVAC CHANGEOUT -
101-0000-42600
0
$36.26
$0.00
SPLIT -SYSTEM PC
Total Paid forCHANGEOUT: $108.78 $0.00
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
TOTALS:0i
MftCTIONS
SEQID INSPECTION -TYPE'. INSPECTORSCHEDULED; COMPLETED RESULT REMARKS NOTES
DATE : DATE ,
MECHANICAL FINAL" BLD
Printed: Monday, July 20, 2015 2:11:57 PM 2 of 2
SYSTEMS
STATE OF CALIFORNIA
ALTERATIONS - HVAC.
CEC-CFIR-ALT-04-E Revised 06/14 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CFIR-ALT-04 E
Alterations - HVAC CZ 2, and 8-15 (formerly CF -1R -ALT -HVAC) (Page 1 of 1)
Side Address:^
Enforcement Agency:
Dae
Prepared:
Permit#:
s?- cx-o Xj Gv�� c v i o
6� L_ Du -% o-
�
zo I S
Equipment Type
Equipment Efficiency
New ucting, Plenums, Lineset:
Conditioned
Thermostat
Required R -value
Floor Area (sq ft)
❑ Packaged System
K Evaporator coil
gp� AFUE
COP
❑ R-6 (CZ 2, 8-13) Ducting
Served by system
XSetback
J8( Split System
❑ Mini Split
X Condensing Unit
❑ Compressor
Iris
❑ R-8' (CZ 11, 14, 15) Ducting
VOL4D_sgft
(If not already
SEER
HSPF❑
R - (all CZ's) Plenums
present must
,Z Furnace
❑ Lineset
EER
❑ R-5 or R7.5) Lineset"
be installed)
❑ TXV
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this
form is allowed to be filled out by hand. For final inspection all forms are to be registered (no hand filled forms allowed) and a copy left on site.
X1. HVAC Changeout/Repair
Required Compliance Documents to be left on site for Final:
All Equipment,
CF1R-ALT-02-E
Condenser Unit, Evaporator Coil,
CF2R: MECH-01, MECH-20-HERS, MECH-(23 or 24)2 -HERS, MECH-25-HERS'
Compressor, TXV, Lineset,
CF3R: MECH-20-HERS, MECH-(23 or 24) -HERS', MECH-25-HERS'
Air Handler/Furnace' (Can include new ducting)
Installer Requirement: Duct leakage (!S.15%, or < 10% to outside, or seal all accessible leaks), Air Flow >_ 300 CFM/ton, Refrigerant Charge.
Exempted from duct leakage testing if:
❑ 1. Duct system registered with HERS provider as previously sealed, or ❑ 2. There is less than 40 linear feet of duct in unconditioned space, or
❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos (list manufacture date of building
❑ 2. New HVAC System Required Compliance Documents to be left on site for Final:
All new equipment and All New Ducts' CFIR-ALT-02-E
including Mini Split CF2R: MECH-01, MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24)-HERSZ, MECH-25-HERS1
CF3R: MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24)-HERSZ, MECH-25-HERS2
Mini Splits require CFIR-ALT-02-E, CF2R-MECH-01, and (CF2R-CF3R) MECH-25-HERS
Installer Requirement: Duct leakage < 6%, Fan Efficacy (.58W/CFM), Air Flow >_ 350 CFM/ton (or alternative), Refrigerant Charge
❑ 3. All New Ducts with Replacement Required Compliance Documents to be left on site for Final:
All New Ducts' and one or more of the following CFIR-ALT-02-E
replaced: Condenser Unit, Evaporator Coil, CF2R: MECH-01, MECH-20-HERS, MECH-(23 or 24) -HERS, MECH-25-HERS
Compressor, TXV, Lineset, Furnace' CF3R: MECH-20-HERS, MECH-(23 or 24) -HERS, MECH-25-HERS
Installer Requirement: Duct leakage < 6%, Air Flow >- 350 CFM/ton (or alternative), Refrigerant Charge
Exempted from duct leakage testing if: ❑ 1. Existing duct systems are constructed, insulated or sealed with asbestos
❑ 4. New Ducting over 40 feet Required Compliance Documents to be left on site for Final:
New ducting but less than All New Ducts' I CF1R-ALT-02-E, CF2R: MECH-20-HERS, CF3R: MECH-20-HERS
Installer Required to: Duct leakage (< 15% or, < 10% to outside or, or seal all accessible leaks)
❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos.
' All new ducting R-8 required when more than 40 ft installed and R-6 when less than 40 ft installed. This includes in walls, between floors etc.
2 Heating only systems and Air Handler/Furnace changes do not require Air Flow MECH-(23 or 24), or Refrigerant Charge verification MECH-25
'All New Ducts is when at least 75 percent of the duct system is new duct material, and up•to 25 percent may consist of reused parts from the
dwelling unit's existing duct system (e.g., registers, grilles, boots, air handler, coil, plenums, duct material)
" R-5 (1" thick insulation) for linesets 1" and less. R-7.5 (1.5" thick insulation) for linesets over 1 inch. Most mfg will require Suction line Diameter
with insulation as the following 1.5-2T-2%", 2.5-3T-2'/.", 3.5 to 4T-2%", 5T-4%"
Contractor (Documentation Author's /Responsible Designer's Declaration Statement)
I certify the following under penalty of perjury, under the laws of the State of California:
1. The information provided on this Certificate of Compliance is true and correct.
2. . I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the information on this document. .
3. That the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the
requirements of Title 24, Parts 1 and 6 of the California Code of Regulations (CCR).
4. That the energy features and performance specifications, materials, components, and manufactured devices for the building design or
system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the CCR.
5. The building design features or system design features identified on this Certificate of Compliance are consistent with the information
provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement
agency forapproval with this building permit application.
Responsible Designer Name:
�'fievev,�Y1
Res onsible Designer Signature:
Date Signed:
License:
i e—
7 7-C>1S
Company:
Ge��c-c k X,
Address:
311�0�es�c�� br
City/State/Zip:
Phone:
_7b0- 3 43 -7 It
;
ror assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300
Iain #
City of La Quinta
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012.
Building Permit Application and Tracking Sheet
Permit #
Project Address:JrZOIo (� AN w�. dG, 1�`,�� 0
Owner's Name: L01S � w
A. P. Number:
Address: 52-04,0 AY
Legal Description:
City, ST, Zip: L c, Ckj- A a e A 92Z 5 3
Contractor: —
G Z r
�n v.
��.� Co a; o r i
Tele
Telephone: -
0 -
Address: 3,1170 ��Sery �t
Project Description:
City, ST, Zip: 1�lrns CA .92Z--I�
�e laic t{�o �: c Coi .' C30, coo
Telephone: le h
o . O 3 -
37
P b �
y
TV yr h a C c
State Lic. # : ice` b310 City Lic. #;
Arch., Engr., Designer:
Address:
City,, ST, Zip:
Telephone:
e one:
P
'.
Contr
s ucti n
o Type: ecu
P Occupancy:
P Y:
i .#•
State Lc
Project ect hPa (circle one): New Ad ' ri Alter er ReA ai r Demo
Name of Contact Person:
Sq. Ft.:
#Stories:
T# Units:
Telephone # of Contact Person:
Estimated Value of Project: �, $ $ $ . Cx7
APPLICANT: DO NOT WRITE.BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cates,
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance
Title 24 Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"'' Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'rd Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees